Understanding the Availability of Mental Telehealth Services

During the coronavirus pandemic, public health measures and restrictions impacted in-person health care visits, leading to a surge in telehealth services as a way of accessing assessment and treatment. Particularly in mental health care, telehealth saw a significant rise, and usage remains high even post-pandemic. However, despite the increased utilization of telehealth services, there’s a limited understanding of the availability and structure of these services.

What did the researchers do?

In an NIMH-funded study, researchers led by Jonathan Cantor, Ph.D. , of the RAND Corporation investigated the availability of different types of telehealth services and the time it took patients to access telehealth care.

Between December 2022 and March 2023, researchers contacted more than 1,900 outpatient mental health care facilities to ask about telehealth services. The underlying sample came from outpatient mental health treatment facilities, not individual practitioners.

The researchers used a secret shopper approach, using a script that mirrored information a prospective patient might ask when inquiring about telehealth services. The secret shoppers asked about the availability of telehealth services for treating major depressive disorder, generalized anxiety disorder, or schizophrenia. They also asked about the specific services offered via telehealth (behavioral therapy, medication management, diagnostic services) and the number of days they would have to wait before having their first telehealth appointment. Both men and women served as secret shoppers, and the names used by the shoppers were chosen to reflect a variety of racial and ethnic backgrounds.

What did the researchers find?

Out of the more than 1,900 facilities contacted, the researchers received replies from 1,404. Among these, 1,221 were accepting new patients. Of those 1,221 facilities, 80% (980) offered telehealth services. Out of the 980 treatment facilities that offered telehealth services:

• 97% provided counseling services
• 77% provided medication management
• 96% provided diagnostic services

Among the facilities that responded to the telehealth question, the researchers found:

• Not-for-profit and for-profit private treatment facilities were more likely to offer telehealth services than public treatment facilities.
• Treatment facilities in metropolitan areas were more likely than non-urban areas to offer medication management but less likely to offer diagnostic services.
• The average wait time for a telehealth appointment was 14 days (ranging from 4 to 75 days, depending on the facility contacted).

What do the findings mean?

The researchers found that some of the facilities they initially reached out to for information did not respond, suggesting that people looking for any type of mental health care may experience barriers to accessing it.

Of the facilities that did respond, most were accepting new patients, and most provided telehealth services; however, the availability of those services and the type of care offered varied by location and state. This suggests there may be disparities in access to telehealth services across the United States.

The researchers note that telehealth services and availability may differ at health centers not included in this study and that the availability of technology that makes telehealth possible—such as broadband services—was not examined in this analysis.